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Non-medical prescribing and the impact on children’s hospice care

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To mark the launch of the third edition of Safe use of medicines, one of the toolkit’s authors Dr Michael Tatterton shares his thoughts on the growth of non-medical prescribing in children’s palliative care.

It was whilst working as a children’s community specialist practitioner within the NHS, that I realised the potential for independent (non-medical) prescribing. The ability to be able to prescribe independently would mean I could make changes to current medicines as well as prescribing new ones for babies, children and young people in my care. This would result in care that was more responsive and reduce my dependence on hospital-based medical colleagues or GPs to prescribe.

I worked at Forget Me Not Children’s Hospice as a Consultant Nurse and Director of Care between 2010-14. At the time, our care services were largely community-based as we were building the hospice. Being able to prescribe made a huge difference to families in our care. It meant that babies, children and young people who required symptom management at home could have doses of medicines changed in response to their symptoms. It meant that we were able to optimise medicines’ safety due to the increased knowledge of prescribers – not only by prescribers but across the whole care team. Having a small team of prescribers meant that we could provide informal support to each other, helping us to develop as individuals and a collective.

When I moved to Martin House as a Consultant Nurse, the potential impact of non-medical prescribing was less clear due to the medical team employed by the hospice. Despite this, we trained and supported the practice of a number of nurses to prescribe independently over a period of four years. This led to a lot of the same benefits that were found at Forget Me Not, including:

  • round the clock access to medicines information
  • a more informed care team, in terms of medicines reconciliation
  • improved responsiveness, in terms of community-based care
  • more timely access to medicines and medicine changes, particularly out of hours
  • increased family satisfaction
  • increased knowledge of pharmacology and medicines, leading to the sharing of knowledge and advice across the care team

In the time between the 2014 and new edition of the Medicines Management Toolkit, interest in non-medical prescribing has grown. There are more non-medical prescribers in the sector than ever before, including nurses and allied health professionals practicing at a specialist and advanced level. As the number of prescribers has increased, so has the curiosity around advanced clinical practice, and where this fits within children’s hospice and palliative care.

Like most practice in children’s hospices, the approach taken to prescribing varies from organisation to organisation. However, it is clear that non-medical prescribers are making a significant contribution to the medicine requirements of babies, children and young people who rely on hospice services, and that this includes elements of advanced clinical practice, such as physiological assessment, history taking and clinical decision making, which underpin prescribing decisions.

In the same way, the content of the new chapter on non-medical prescribing has evolved, to include advanced level practice. It explores the benefits and challenges of prescribing and advanced practice, and how organisations can utilise the skills of practitioners to improve the care experience of children and their families, and the safety and responsiveness of services provided.

Dr. Michael Tatterton is Associate Professor (Children’s Nursing), Faculty of Health Studies, University of Bradford

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